Culturally Competent

Medical Care
CLPR 5020
Week 3a
SCNM
S
 Cultures
Cultures are made of
continuities and
changes, and the
identity of a society can
survive through these
changes. Societies
without change aren't
authentic; they're just
dead.
Kwame Anthony Appiah,
Reference
 Reference
The content of this lecture is from:
Mosbys Cultural Health
Assessment, 3rd edition, bu
Carolyn Erickson DAvanzo.
Patients may present on any point in
a spectrum of personal cultural
experience or in a very different
manner
Gathering knowledge of all the
experiences that make a life rich
and complex is our duty.
Patients Role
o Passive Role: I go to the doctor so they can
cure me.
o Active Role: I go to the doctor so that I can
learn how to get well. I take part in decision
making.
o Acute Care: Come to doctor in sickness.
o Preventative: Come to doctor in health.
o [We should recognize that prevention can be
put in place in any stage of health or disease.]
 Predomient Sick-care
Practices
Biomedical -
Traditional -
Holistic -
Magical-religious -
o Example-Iran: Active health
promotion, traditional
o Prevention and health promotion are the
major components of the health care
system.
 Practitioners Role
o In Mexican culture the healthcare
system is physician driven with strict
organization of power and duties. The
practitioners are considered outsiders
where as a curadero (folk-healer),
yerbaro (herbalist) are more apart of
the family network with a special
relationship to the patient.
o Medicine that is considered alternative
in the US may be traditional elsewhere,
i.e. , homeopathy.
Homeopathy in India, South America
and Europe
Influences in Illness
o In Mexican culture:

o Mal de ojo (evil eye or too much

admiration)
o Empacho (bolus stuck in intestines)
o Ciada de mollera (fallen fontanel)
o Susto (fear or fright cause of illness)
o Mal puesto (hex or illness imposed by
another)
Influences in Illness
In Cambodian culture serious illness after
travel is believed due to wrong diet or violation
of certain rituals or pledges. Food and
apologizes are offered to the spirits
o A common belief is that thinking too much
during periods of stress creates mental
imbalance.
o Self treatment strategies may be
suppressing sad thoughts, being
sheltered and protected by family, being
encouraged to laugh and not being left
alone. Healthful approach
 Hot and Cold Theory
o In Cambodian, Mexican and Iranian culture
Cold illnesses invade the body from the
exterior, may be alterations in motor or
sensory function, pain and immobility.
o Hot illnesses are generated from the interior,
these may be skin rashes, fever and cough.
o Guatemalan culture also uses Hot and cold
characterization of medicine and illness. But
the Penicillin is cold and would treat a fever
whereas it would not treat a cold disease
such as pneumonia.
 Hot and Cold Theory
o In Cambodian culture Yin cold and yang
hot concepts have wide influence and
must be in equilibrium for optimum
health.
o Childbirth: considered a cold process
so cold bath, foods are rejected.
Warming meals and spices are desired
o Herbal medicines are considered cold
and western medicines hot.
 Spiritual Cures
o Mexican culture: Spiritual diseases may be
cured through limpias or cleaning of the soul
or leida de la suerte a reading of destiny.
o Prayer and the uses of religious relics,
rosaries and crucifixes are part of a strong
religious practice.
o Many illness attributed to presence of angry
spirits within a person.
 Family Hierarchy
o In Mexican culture and as we saw in Hmong
culture the male head of household should be
consulted on healthcare decisions. Mothers
may not be able to consent to treatment on
child in some cases.
o In Guatemalan culture others are looked to for
emotional support and the father for financial
care. But roles are broadening. There may
be a double standard in marital fidelity, wives
are expected to be faithful and ignore
extramarital affairs of husband. Machismo
drives this still a predominant standard.
 Family Hierarchy

o In Somali culture women have a high

status in the family and are head of the
family unit.
o Iranian culture is patriarchal society with
father, grandfather or oldest son in
dominant position lead. Women are not
equal but well educated at 62% go to
university.
 Family & Hospital
Stays
o In some cultures family plays a big role
in illness and many family members
will go to the hospital to stay with the
one who is sick.
o In these same or other countries
families are tasked to go out and
purchase all medical supplies,
medications and food needed while the
patient is in the hospital.
 Pregnancy Child Care
Mexican culture breastfeeding is accepted for
the first 4 months. Colostrum is seen as
bad milk and thrown away.
o Somali culture is extremely supportive of the
expectant and new mothers.
o Neonatal care includes warm baths, sesame
oil massages and passive stretching of
infants limbs.
o Breastfeeding until 2 years of age.
o Male circumcision by age 5
 Pain Expression

o Croatian pain reaction is individual. People

in the Mediterranean south are more
expressive.
o Cambodian culture exhibit a greater pain
tolerance than many westerners. Men do
not seek medical care for pain unless it is
severe. Women seek care for lesser aches
and pains but are amazingly stoic in
childbirth. Analgesia or anesthesia is
uncommon in labor even in public hospitals.
 Pain Expression
o Iran: Reactions to pain are quite
expressive accompanied by crying and
screaming. These behaviors are
acceptable in women.
o Emotional problems take somatic form.
 Eye Contact
o Guatemalan culture urban and
professional arena direct eye contact is
expected.
o Rural area it is widely believed that a
strong person can drain a weaker
person by staring, via mal de ojo.
Symptoms will be fever, vomiting.
diarrhea, difficulty sleeping and
inconsolable crying. A curandero is
sought to remedy this.
o .
 Eye Contact
o Croatian culture direct eye contact is
acceptable. Not maintaining eye
contact while talking to someone is
considered impertinent.
o Iranian culture: as a sign of respect
lower status person avert eyes on
meeting of one of higher status.
Female modest prohibits eye contact
with a man not from the family.
 Touch, Personal Space
o Croatian culture, kissing on both cheek
among family or close friends is
customary. Others usually greet with
hand shake
o In Mexican culture, touch is common
and encouraged. Its considered
complimentary and neutralizes the
power of the mal de ojo
 Touch, Personal Space
o Guatemalan culture touch is important and
expected if something like head pain is to be
diagnosis by both Western practitioners and
curanderos.
o In Cambodian culture speaking loudly, yelling,
snapping fingers under the nose, pointing and
beckoning with a finger or holding hands
outstretched with palm up offend.
o Touching a child on their head may be seen
as offensive.
 Tea of Seven
Blossoms
o TE DE SIETE AZAHARES
o Passion Flower, Linden Flower, Rose Petals,
Chamomile, Anise Seeds, Skullcap and Tilo Star
 Diet and Nutrition
o In Somali culture Halal eating in
accordance to Islamic beliefs is upheld. An
animal that eats another animal or pork is
unclean. Must be prepared in a particular
manner.
o Ramadan holy days are fasted with eating
only occurring after sundown.
o Israeli observant Jews eat only animals with
hooves that are kosher
slaughtered/processed and only seafood that
have scales. Milk and meat are not eaten at
he same meal.
Food as Medicine
 Language
o In Guatemala Spanish is the official
language but with ethnic groups
divided between European and Ladino
at 60% and indigenous Amerindian at
40% there are 23 officially recognized
dialects.
 Psychological Illness
o Cambodia: PTSD is common in older adults
who lived through the Khmer Rouge period
after the Vietnam war.
 Method of Delivery
o Cambodian injections are considered more
effective.
o Local practitioner in Phoenix reports that their
Mexican patients expect an injection as
treatment as each visit.
o I have not observed this expectation. But
know that patient regularly get antibiotic
injections from the local herbaria's.
 Psychological Illness
o Cambodia: PTSD is common in older adults
who lived through the Khmer Rouge period
after the Vietnam war.
o Iran: Mental health is integrated into the
health system, but traditional healers still play
a major role in treating.
o Emotional problems tend to be expressed
somatically in the form of headaches,
intestinal problems and insomnia.
 Culture and Progress

The ideal of a single civilization

for everyone implicit in the cult
of progress and technology
impoverishes and mutilates us.
Every view of the world that
becomes extinct, every culture
that disappears, diminishes a
possibility of life.